Dental appliance having ornamental design

ABSTRACT

A dental appliance having an integrally formed reservoir and/or an ornamental design integrated thereon. The ornamental design can be selected or customized by a patient. The design can be created by directing energy to the dental appliance to alter a material property of at least a portion of the appliance to create the design. Alternatively, a groove or recess can be formed on a surface of the appliance to either mechanically retain an ornamental design or the groove or recess can be filled with ink to form the design. The appliance, including the integrally formed reservoir, can be formed using direct fabrication techniques.

CROSS REFERENCE

This application claims the benefit of U.S. Provisional PatentApplication No. 62/189,303, filed on Jul. 7, 2015 and entitled “SYSTEMS,APPARATUSES AND METHODS FOR DRUG DELIVERY FROM DENTAL APPLIANCES WITHINTEGRALLY FORMED RESERVOIRS” and U.S. Provisional Patent ApplicationNo. 62/189,318, filed on Jul. 7, 2015 and entitled “DENTAL APPLIANCEHAVING ORNAMENTAL DESIGN”

The subject matter of the following patent applications is related tothe present application: U.S. Application Ser. No. 62/189,259, filed onJul. 7, 2015, entitled “MULTI-MATERIAL ALIGNERS”; U.S. Application Ser.No. 62/189,263, filed on Jul. 7, 2015, entitled “DIRECT FABRICATION OFALIGNERS WITH INTERPROXIMAL FORCE COUPLING”; U.S. Application Ser. No.62/189,291, filed on Jul. 7, 2015, entitled “DIRECT FABRICATION OFORTHODONTIC APPLIANCES WITH VARIABLE PROPERTIES”; U.S. Application Ser.No. 62/189,271, filed on Jul. 7, 2015, entitled “DIRECT FABRICATION OFALIGNERS FOR ARCH EXPANSION”; U.S. Application Ser. No. 62/189,282,filed on Jul. 7, 2015, entitled “DIRECT FABRICATION OF ATTACHMENTTEMPLATES WITH ADHESIVE”; U.S. Application Ser. No. 62/189,301, filed onJul. 7, 2015, entitled “DIRECT FABRICATION CROSS-LINKING FOR PALATEEXPANSION AND OTHER APPLICATIONS”; U.S. Application Ser. No. 62/189,312,filed on Jul. 7, 2015, entitled “SYSTEMS, APPARATUSES AND METHODS FORDENTAL APPLIANCES WITH INTEGRALLY FORMED FEATURES”; U.S. ApplicationSer. No. 62/189,317, filed on Jul. 7, 2015, entitled “DIRECT FABRICATIONOF POWER ARMS”; and U.S. Application Ser. No. 62/189,380, filed on Jul.7, 2015, entitled “DENTAL MATERIALS USING THERMOSET POLYMERS”, theentire disclosures of which are hereby incorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention relates generally to dental appliances. Moreparticularly, the invention relates to dental appliances for drugdelivery with integrally formed reservoirs and dental appliances capableof displaying an ornamental design.

Dental appliances, such as braces (wire brackets) and retainers, havebeen used by teenagers and adults for several decades to straighten andmaintain tooth positioning. However, these dental appliances,particularly wires and brackets, can be unsightly, uncomfortable, andcumbersome for the patient.

To address these issues with wires and brackets, removable polymericshell appliances (e.g., aligners) were developed to straighten teeth.Clear aligners, such as the Invisalign® aligners manufactured by AlignTechnology, Inc. of San Jose, Calif., are virtually invisible as well ascomfortable. Such appliances may have a thin shell of plastic materialthat generally conforms to a patient's teeth but is slightly out ofalignment with an initial or immediately prior tooth configuration.Placement of the appliance over the teeth applies controlled forces inspecific locations to gradually move the teeth into the newconfiguration. Repetition of this process with successive appliancescomprising new configurations eventually moves the teeth through aseries of intermediate configurations or alignment patterns to a finaldesired configuration. A number of dental and periodontal therapieswhich may be desired or required by the patient may not be effectivelyutilized while the appliance is in place, in some instances. Suchtherapies may be prescribed by a practitioner to improve oral health orthey may be requested by the patient for cosmetic purposes.

Unlike patients with braces, the patient wearing aligners has thefreedom to eat anything he or she desires because the aligners areremovable. Furthermore, removable aligners allow for easier care andcleaning of teeth. Patients are able to customize their braces bychoosing the colors for the wires and brackets as well as the rubberbands that are worn with the wires and brackets. This ability tocustomize is especially attractive to teenagers. Thus, it would bedesirable to provide aligners that are capable of being integrated withcolor and/or customized by the patient and/or also capable of providingtherapies for a patient.

Furthermore, sometimes therapies and agents are provided with a varietyof accessories and devices that are applied when the receiving applianceis removed from the patient's mouth. Thus, it would be desirable toprovide an appliance that can provide a drug delivery method withoutremoval of the appliance, which can eliminate the need for such removaland additional devices by integrating such therapies with the appliance.

SUMMARY OF THE INVENTION

In accordance with an embodiment, a method is provided for providing adesign on a dental appliance having a geometry configured to receiveteeth. The appliance is provided and the appearance of at least aportion of the appliance is altered to provide the design on theappliance.

In accordance with another embodiment, a method is provided forproviding a design on a dental appliance having a geometry configured toreceive teeth. The appliance is provided and an etching device, heat, orother energy is directed to at least a portion of the appliance to altera material property of the at least a portion of the appliance to alteran appearance of the at least a portion the appliance.

In accordance with yet another embodiment, a method is provided forfabricating a dental appliance having an ornamental design thereon. Thedental appliance has a geometry shaped to receive teeth. The applianceis formed from a sheet comprising a plurality of layers. An etchingdevice, heat, or other energy is directed to at least a portion of theappliance to remove at least one layer of material from the appliance toreveal a portion of a layer of the appliance.

In accordance with another embodiment, a method is provided forproviding a design on a dental appliance that has a geometry shaped toreceive teeth. A selection of digital images or an ability to upload orcreate a customized image is provided for use as the design integratedwith the dental appliance. Selection of an image is allowed from theselection or uploading of a customized image for use as the design forintegration with the dental appliance. A selected or uploaded design isstored.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention, together with further objects and advantages thereof, maybest be understood by reference to the following description taken inconjunction with the accompanying drawings in which:

FIG. 1 is a perspective view of a dental appliance in accordance with anembodiment.

FIG. 2A is a perspective view of a dental appliance in accordance withanother embodiment.

FIG. 2B is a detailed view of an ornamental design on the dentalappliance shown in FIG. 2A.

FIG. 3A is a front view of a dental appliance in accordance with yetanother embodiment.

FIG. 3B is a side cross-sectional view of a multilayer polymer sheetused to form the dental appliance shown in FIG. 3A.

FIG. 3C illustrates a tooth receiving appliance comprising a shell withan integrally formed reservoir, in accordance with an embodiment.

FIG. 3D illustrates a tooth receiving appliance comprising a shell withan integrally formed reservoir, the shell and the integrally formedreservoir comprising the same material in accordance with an embodiment.

FIG. 3E illustrates a tooth receiving appliance comprising a shell withan integrally formed reservoir, the shell comprising a first materialand the integrally formed reservoir comprising a second material inaccordance with an embodiment.

FIG. 3F illustrates a tooth receiving appliance comprising a shell withan integrally formed reservoir, the shell comprising a first materialand the integrally formed reservoir comprising a first and a secondmaterial in accordance with an embodiment.

FIG. 3G illustrates a cross-section view of a shell and an integrallyformed reservoir comprising a rate controlling membrane in accordancewith an embodiment.

FIG. 3H illustrates a tooth receiving appliance comprising a shell withan integrally formed reservoir in accordance with an embodiment.

FIG. 4A is a front view of a dental appliance having an ornamentaldesign mechanically attached in accordance with an embodiment.

FIG. 4B is a side view of a dental appliance having an ornamental designmechanically attached in accordance with an embodiment.

FIG. 5 depicts a process for fabricating a dental appliance inaccordance with an embodiment.

FIG. 6 is a flow chart of a process for fabricating a dental appliancein accordance with an embodiment.

FIGS. 7A-7D show an embodiment of a dental appliance having anornamental design formed using direct fabrication.

FIG. 8 is a flow chart of a process for fabricating a dental appliancein accordance with another embodiment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention relates generally to dental appliances. Moreparticularly, the appliance relates to dental appliances capable ofdisplaying customizable ornamental designs and/or labels and for drugdelivery. Dental appliances, including retainers, positioners, andaligners, with integrally formed reservoirs are capable of drug deliveryas well as displaying integrated designs and colors. Integrated designsand colors, particularly those that are selected or even created by thepatient, provide the patient with the ability to customize theappliance. These dental appliances provide patients with even moreopportunity for customization than colored wired and brackets.

A reservoir can be any structure or material containing an agent fortreating a patient, such as a layer, coating, recess, cavity, chamber,membrane, scaffold, and the like. As used herein, “integrally formedreservoir” may refer to a reservoir formed as a single unitary ormonolithic piece with another appliance component (e.g., an applianceshell with teeth receiving cavities), such that the reservoir cannot beseparated from the appliance without damaging or destroying theappliance component. An integrally formed reservoir may bedifferentiated from a reservoir that is formed and/or providedseparately from the appliance and is subsequently coupled to theappliance component (e.g., by adhesives, fasteners, coating, layering,spraying, painting, dipping, etc.). In some embodiments, an integrallyformed reservoir is concurrently formed with another appliance componentin a single manufacturing or fabrication step, such that the samefabrication machine and/or fabrication process is used to produce boththe reservoir and the appliance component. Accordingly, an integrallyformed reservoir may be differentiated from a reservoir that is formedprior to or after the appliance component is formed, and may bedifferentiated from a reservoir that is formed using a differentfabrication process than the process used to form the appliancecomponent. For example, the various direct fabrication methods discussedherein can be used to produce both the appliance component and theintegrally formed reservoir concurrently in a single fabrication step.

An aligner is a relatively thin shell of material that generallyconforms to a patient's teeth but is slightly out of alignment with thecurrent tooth configuration. The material of the aligner is typically apolymeric material that has resilient properties. Dental treatmentsusing aligners typically involve repositioning misaligned teeth andchanging bite configurations for improved cosmetic appearance and dentalfunction. Such repositioning with aligners can be accomplished byapplying controlled forces to one or more teeth over a period of time.

As noted above, placement of such an appliance over the teeth providescontrolled forces in specific locations to gradually move the teeth intoa new configuration. Repetition of this process with successiveappliances that provide progressive configurations eventually move theteeth through a series of intermediate arrangements to a target,prescribed, or desired arrangement. An example of such a system isdescribed in U.S. Pat. No. 5,975,893, which is hereby incorporatedherein by reference.

Once the teeth have been repositioned to a final desired arrangement,they typically need to be maintained in the desired arrangement toprevent the teeth from moving out of the desired arrangements. Suchmaintenance can be accomplished by wearing a retainer, which similar toan aligner can also be a polymeric shell appliance. The retainer may,but does not have to, impart force to any of the teeth (e.g., forre-positioning). In some embodiments, the appliance serves the purposeof receiving teeth to enable methods of drug delivery to the patientrather than repositioning the patient's tooth or teeth in addition tomethods of drug delivery. The appliances described herein may befabricated with integrally formed reservoirs to achieve methods of drugdelivery alone or in combination with repositioning the patient's toothor teeth. In some aspects, the reservoir can be positioned away fromportions of the appliance used to apply forces to the teeth.

Embodiments of a dental appliance having an ornamental design thereonwill be described herein. In an illustrated embodiment, the dentalappliance 100 has a geometry for receiving teeth. As shown in FIG. 1,the dental appliance 100 can be configured to fit over an entire dentalarch 120. In other embodiments, the dental appliance may be designed tofit over some or all of the teeth in the upper or lower jaw. The dentalappliance 100 can be fabricated from a polymeric shell, or formed fromanother material, and include a number of cavities shaped to receivecorresponding teeth.

In some embodiments described herein, systems, methods and devices fordrug delivery tooth receiving appliances with integrally formedreservoirs include an appliance for intra-oral delivery of one or moreagents to a patient. Such appliances can include a shell forming aplurality of cavities shaped to receive teeth of a mouth of the patient,and a reservoir that is integrally formed within the shell. Thereservoir is configured to receive, store and release an agent to thepatient. The shell may encompass the reservoir such that the volume ofthe reservoir is less than the volume of the shell in the absence of thereservoir. In some aspects of the embodiments, the shell furtherincludes a channel integrally formed within the shell. In some aspectsof the embodiments, the shell and the reservoir comprise a firstmaterial, or the shell comprises the first material and the reservoircomprises a second material, or the reservoir comprises the firstmaterial and the second material. In some aspects of the embodiments,the reservoir is hollow or filled with a porous material, the porousmaterial comprising the second material or a third material. In someaspects of the embodiments, the second or the third material is adegradable material or a material configured to release an agent bydiffusion. In some aspects of the embodiments, the porous materialfurther comprises pores having a diameter of about 50 μm, about 30 μm,about 20 μm, about 15 μm, about 10 μm, about 5 μm, about 1 μm, about 500nm, about 100 nm, about 10 nm, or about 1 nm. In some aspects of theembodiments, the porous material further comprises pores having the samediameter or having different diameters.

The porous properties of a material can be used as a method ofcontrolling diffusion of an agent from the integrally formed reservoir.For example, larger pores, such as 50 μm may be selected as the diameterof the pores in the porous material when the agent is of a smallmolecular weight, thus the porous material is configured for a higherrate of diffusion of the agent through the pores and into the intraoralcavity. As another example, medium-sized pores, such as 25 μm may beselected as the diameter of the pores in the porous material when theagent is of a small molecular weight, thus the porous material isconfigured for a medium rate of diffusion of the agent through the poresand into the intraoral cavity. The plurality of agents described hereinor others known to one of skill in the art can comprise a plurality ofmolecular weights. The pore sizes described herein or others known toone of ordinary skill in the art of the porous material can be selectedduring the methods of manufacturing and/or fabricating the shell inorder to facilitate a desired rate of delivery and/or desired rate ofdiffusion of the agent from the integrally formed reservoir. The firstmaterial may be selected from a material as described herein or known toone of ordinary skill in the art and often, but is not limited to,lacking degradable properties.

In some aspects of the embodiments, the reservoir comprises at least oneport, wherein the at least one port is an outlet port, an inlet port ora universal port. In some aspects of the embodiments, the outlet portand the universal port are configured to release an agent into the mouthof the patient in response to a stimulus or to release an agent into thechannel of the shell in response to a stimulus. In some aspects of theembodiments, the agent is a pharmaceutical composition, a chemical, agene, a polypeptide, an enzyme, a biomarker, a dye, a complianceindicator, an antibiotic, an analgesic, a medical grade drug, a chemicalagent, a bioactive agent, an antibacterial, an antibiotic, ananti-inflammatory agent, an immune-suppressive agent, animmune-stimulatory agent, a dentinal desensitizer, an odor maskingagent, an immune reagent, an anesthetic, a nutritional agent, anantioxidant, a lipopolysaccharide complexing agent or a peroxide. Insome embodiments where the appliance is generated by a fabricationmachine according to a set of fabrication instructions, the fabricationinstructions comprise the steps of generating a digital model of theshell, the digital model including the reservoir integrally formed intothe shell, and fabricating the shell having the reservoir integrallyformed into the shell during a single fabrication step.

In some embodiments, the dental appliance 100 is an orthodonticappliance, such as an aligner, configured to move teeth from oneposition to a successive position. In other embodiments, the dentalappliance 100 is an appliance, such as a retainer, configured tomaintain the positioning of the teeth.

According to embodiments, the dental appliance includes a removableorthodontic tooth positioning appliance having teeth receiving cavitiesshaped to directly receive at least some of the patient's teeth andapply a resilient positioning force to the patient's teeth. An appliancecan fit over some or all teeth present in an upper or lower jaw. In somecases, only certain teeth received by an appliance will be repositionedby the appliance while other teeth can provide a base or anchor regionfor holding the appliance in place as it applies force against the toothor teeth targeted for repositioning. In some cases, many or most, andeven all, of the teeth will be repositioned at some point duringtreatment.

Teeth that are moved can also serve as a base or anchor for holding theappliance as it is worn by the patient. Typically, no wires or othermeans will be provided for holding an appliance in place over the teeth.In some cases, however, it may be desirable or necessary to provideindividual anchors on teeth with corresponding receptacles or aperturesin the appliance so that the appliance can apply a selected force on thetooth. Exemplary appliances are described in numerous patents and patentapplications assigned to Align Technology, Inc. including, for example,in U.S. Pat. Nos. 6,450,807, and 5,975,893, as well as on the company'swebsite, which is accessible on the World Wide Web (see, e.g.,www.invisalign.com). The aforementioned patents are hereby incorporatedherein for all purposes.

An appliance can be designed and/or provided as part of a set of aplurality of appliances. In such an embodiment, each appliance may beconfigured such that a tooth-receiving cavity has a geometrycorresponding to an intended intermediate or final tooth arrangement.The patient's teeth can be progressively repositioned from an initialtooth arrangement to a target tooth arrangement by placing a series ofincremental position adjustment appliances over the patient's teeth. Atarget tooth arrangement is a planned tooth arrangement (e.g., a plannedtemporary or final arrangement) selected for the patient's teeth at aspecific stage of the planned orthodontic treatment. A targetarrangement can be one of many intermediate arrangements for thepatient's teeth during the course of orthodontic treatment, which mayinclude where surgery is recommended, where inter-proximal reduction(IPR) is appropriate, where a progress check is scheduled, where anchorplacement is best, where palatal expansion is desirable, etc. As such,it is understood that a target tooth arrangement can be any plannedresulting arrangement for the patient's teeth that follows one or moreincremental repositioning stages. Likewise, an initial tooth arrangementcan be any initial arrangement for the patient's teeth that is followedby one or more incremental repositioning stages.

The adjustment appliances can be generated all at the same stage or insets or batches, e.g., at the beginning of a stage of the treatment, andthe patient wears each appliance until the pressure of each appliance onthe teeth can no longer be felt or has resulted in the maximum amount ofexpressed tooth movement for that given stage. A plurality of differentappliances (e.g., set) can be designed and even fabricated prior to thepatient wearing any appliance of the plurality. After wearing anappliance for an appropriate period of time, the patient replaces thecurrent appliance with the next appliance in the series until no moreappliances remain. The appliances are generally not affixed to the teethand the patient may place and replace the appliances at any time duringthe procedure (e.g., patient-removable appliances).

The final appliance or several appliances in the series may have ageometry or geometries selected to overcorrect the tooth arrangement,i.e., have a geometry which would (if fully achieved) move individualteeth beyond the tooth arrangement which has been selected as the“final.” Such over-correction may be desirable in order to offsetpotential relapse after the repositioning method has been terminated,i.e., to permit movement of individual teeth back toward theirpre-corrected positions. Over-correction may also be beneficial to speedthe rate of correction, i.e., by having an appliance with a geometrythat is positioned beyond a desired intermediate or final position, theindividual teeth will be shifted toward the position at a greater rate.In such cases, the use of an appliance can be terminated before theteeth reach the positions defined by the appliance.

According to an embodiment, as shown in FIG. 1, the ornamental design110, which can include one or more designs as well as labels, can beintegrated with the appliance 100. Some patients may choose to integratethe design 110 particularly in the anterior or social six portion of theappliance 100 so that the design 110 can be readily seen by others whenthe appliance 100 is worn by a patient. The term “social six” refers tothe six teeth at the front of the upper arch that are seen the most whena person is talking or smiling. It will be understood that in FIGS. 1-4,a star shape is provided as the ornamental design, but that any image(including words) can be used as the ornamental design, as theornamental can be customized by a patient in some embodiments.

In other embodiments, the ornamental design or label 110 can bepositioned on different parts of the appliance 100. The design 110 canbe either colored or gray scale and can be selected or even customizedby the patient. The color(s) can also be customized. It will beunderstood that the design 110 shown in FIG. 1 is an exemplary designand that, in other embodiments, the design 110 can be different and alsopositioned on a different area of an appliance 100.

As will be explained in more detail below, the design 110 can beintegrated with the appliance 100 in a variety of different ways. Forexample, the design 110 can be printed onto the appliance 100 or heatenergy can be directed at the appliance 100 to form the design 110 onthe appliance 100. In other embodiments, the ornamental design can bemechanically attached to the appliance or mechanically etched onto asurface of the appliance.

In an embodiment where the dental appliances 100 are orthodonticappliances, such as aligners, in a series of appliances, the design 110can be customized by the patient for each individual appliance in theseries. Furthermore, in an embodiment where the design 110 ismechanically attached to the appliance, the patient can have a set ofdifferent designs that can be interchangeably attached to theappliance(s), as will be explained in more detail below.

The appliance 100 can be fabricated using a variety of differentsuitable methods, including thermoforming, casting, 3D printing,stereolithography, milling, direct fabrication etc. For example, as willbe described in more detail below, methods for making the appliances caninclude thermoforming a polymer sheet into an aligner by heating thesheet and then molding the sheet to a particular configuration.Exemplary methods for fabricating the appliances are described innumerous patents and patent applications assigned to Align Technology,Inc. including, for example, in U.S. application Ser. No. 13/186,374 aswell as on the company's website, which is accessible on the World WideWeb (see, e.g., www.invisalign.com). The aforementioned patentapplication is hereby incorporated herein for all purposes.

FIGS. 2A and 2B show a dental appliance 200 formed from a polymericmaterial having an ornamental design 210 that is formed by removingportions of the polymeric material to form one or more grooves orrecesses, which can be filled with colored ink. The grooves or recessescan be formed by methods, such as by etching or laser scribing. Theappliance 200 can display an ornamental design 210 that can be selectedor customized. According to an embodiment, the ornamental design 210 canbe laser scribed onto a surface of the appliance 200 by directing laserenergy to the appliance 200. Alternatively, the design 210 can be etchedor milled onto a surface of the appliance 210. In still otherembodiments, the appliance 200 can be fabricated on a mold with positivefeatures to result in grooves formed in the appliance 200. It will beunderstood that the ink needs to have sufficient flexibility to flexwith the appliance 200. If the ink does not have sufficient flexibility,the design 210 crack and/or shear off from the appliance 200.

The design 210 can also be colored by first etching or sintering thedesign 210 to form a groove, series of grooves, or recess(es) 220 toform the design 210. The groove(s) or recess(es) can then be filled withcolored ink. The ink can include one or more colors, as desired. Thus,the design 210 can be gray scale if no ink is used or can bemonochromatic or multi-colored, depending on the desired design. Asnoted above, the design 210, including the color(s), is entirelycustomizable. Biocompatible ink made of biocompatible curable liquidscan be used to provide the design 210 with color. For example, groovesor recesses can be filled with biocompatible ink. In one embodiment, onecolor can be used to fill each groove. It will be understood that thesame color can also be used to fill more than one groove, depending onthe particular design. It will be understood that, in some embodiment,the appliance 200 can be formed from a multilayer sheet of polymericmaterial such as the one described below with reference to FIGS. 3A and3B.

In some embodiments, a polymeric shell appliance can be provided with anornamental design 110, 210 to indicate compliance with the treatmentplan. Appliance compliance indicators are described in U.S. Pat. No.7,854,609, which is hereby incorporated by reference herein in itsentirety for all purposes. Since polymeric shell appliances areremovable by the patient, the dentist or orthodontist must rely on thepatient to wear the appliance and comply with the prescribed treatmentplan. According to an embodiment, the ornamental design 110, 210 canchange based on the controlled-release of a colored material that isencapsulated within a membrane or reservoir attached to the appliance100, 200. The membrane or reservoir can cover all or a portion of thedesign 110, 210 that is filled with a colored controlled-releasematerial and the membrane or reservoir has at least one small pore init. When the appliance is worn by the patient, the small pore(s) in themembrane will gradually open and allow the colored controlled-releasematerial within the membrane to dissipate. In some embodiments, themembrane is formed of a material that will warm up (in the patient'smouth) and the colored substance will also warm up so that it can flowout of the premade pore in the membrane.

In other embodiments, the membrane is formed of a material that willstretch with time as the appliance is worn by the patient, allowing thecolored substance to flow out. If the membrane encapsulating the coloredcontrolled-release material is in a region that will stretch wheninserted, the stretch of the membrane could open a slit in the membraneto allow the color to disappear while the slit is stretched due to theflexing of the appliance and the membrane due to the forces beingapplied by the appliance to move the teeth. Once the teeth have beenmoved to the prescribed position for the particular appliance, themembrane will no longer stretch and the color will be gone.

Thus, the patient will know that the appliance has been worn long enoughwhen some aspect of the design 110, 210 has faded away. In one exemplaryembodiment, the design 110, 210 can include a permanent portion of thedesign spelling “happy” and another portion of the design covered by amembrane with pores spelling “be” before the “happy” portion. The porescan expand under body temperature and allow the coloredcontrolled-release material in the “be” portion to dissipate. Thus, whenthe patient has worn the appliance for the appropriate amount of time,the “be” will disappear and the design 110, 210 will only read “happy”.In other embodiments, the design 110, 210 can change in different ways.For example, the design 110, 210 could disappear completely, changecolor, or could turn into a different design. According to otherembodiments, the interaction of heat and/or saliva with a substancecauses a colored design 110, 210 to appear when the appliance has beenworn long enough to indicate compliance.

In some embodiments, the compliance indicator has a clear,tooth-colored, or esthetically pleasing polymer reservoir well, chamber,or housing. A transparent or translucent semi-permeable membraneseparates the content within the reservoir chamber from the externaloral environment which may comprise degradable materials and/or porousmaterials as described herein. The contents) of the agent within theintegrally formed reservoir depends on the overall strategy to monitorcompliance. For example, contents diffuse out from the integrally formedreservoir, through the membrane, the external environment. The contentcan be an FDA approved visible dye which diffuses from the chamber,through the membrane, and into the external oral environment. When thecontent is emptied, the content color diminishes in brightness andvalue. Colorants that are permitted for direct addition to human food bythe US FDA include annatto extract, beta-carotene, beet powder,canthaxanthin, caramel color, carrot oil, cochineal extract (carmine);cottonseed flour, fruit paprika, riboflavin, saffron, turmeric,vegetable juice, FD&C Blue No. 1 (brilliant blue) and No. 2(indigotine), FD&C Green No. 3 (fast green FCF), FD&C Red No. 3(erythrosine) and No. 40 (allura red), FD&C Yellow No. 5 (tartrazine)and No. 6 (sunset yellow). Other food colorants such as those found atFDA's Center for Food Safety and Applied Nutrition website:http://www.cfsan.fda.gov/.about.dms/col-toc.html can be used as well.

In another aspect, matter from the external environment diffuse in, andreacts with the contents within the integrally formed reservoir. Forexample, glucose molecules from the external environment can diffusethrough the membrane, and react with enzymes inside the content and theresultant enzymatic products interact with other reactants inside thecontent to cause color change. As more glucose molecules diffuse in,content color increases in brightness and value. A convenient enzymesystem is glucose oxidase and horseradish peroxidase. The first enzyme,glucose oxidase, catalyzes the oxidation of glucose to form gluconicacid and hydrogen peroxide. Hydrogen peroxide then reacts with3-3,5,5′-tetramethylbenzidine (TMB) under catalytic action ofhorseradish peroxidase to convert yellow TMB to green. Other colorants,such as potassium iodide (green to brown) may also be used. Theseenzymes can be immobilized within the integrally formed reservoir. Therate of reaction, and hence color change, can be controlled by selectingthe permeability of the membrane, the concentration of reactants insidethe integrally formed reservoir, and the method of delivery. The rate ofreaction or concentration of the glucose molecules can also be detectedthrough spectroscopy or other analytical testing. Test results willcorrelate with compliance to treatment.

A compliance indicator can be a dye encapsulated in a polymer or othercompound as described herein or the compliance indicator can be releasedin the presence of oral fluids. The dye can be colorants that react withthe oral fluids and that are released from the polymer. The polymer canbe porous polymer such as monolithic porous polymer (currently used inchromatography), PVS, a high internal phase emulsion (HIPE polymercurrently used in drug release), or any macroporous polymer. The dyedpolymer will be constructed into a small button that can be bonded tothe exterior of the aligner. The amount of dye loss will correspond withthe amount of time the aligner was in use. The pore size of the polymerand the particle size of the dye will affect the rate of diffusion ofdye from the button to the oral fluids environment and depending oncompliance needs, these factors can be controlled.

According to other embodiments, as shown in FIGS. 3C-3H, a reservoir isintegrally formed with a polymeric shell appliance for drug delivery. Insome embodiments, the systems, methods and devices for drug deliverytooth receiving appliances with integrally formed reservoirs include amethod for fabricating an appliance for intra-oral delivery of one ormore agents to a patient, the method comprising: generating a digitalmodel of the appliance, the digital model comprising a digitalrepresentation of a shell comprising a plurality of teeth receivingcavities and a digital representation of a reservoir integrally formedwithin the shell; and generating instructions for fabricating theappliance with the shell and integrally formed reservoir using a directfabrication technique, based on the digital model. In some aspects, adirect fabrication technique comprises one or more of:stereolithography, selective laser sintering, fused deposition modeling,or 3D printing. In some aspects, the instructions are configured tocontrol a fabrication machine to form the reservoir concurrently withthe shell.

As noted in commonly owned U.S. Pat. No. 6,607,382 entitled “Methods andsystems for concurrent tooth receiving and substance delivery,” thecontent of which is incorporated herewith, the receiving of teeth may beaccomplished with the use of a series of removable elastic positioningappliances such as the Invisalign® system available from AlignTechnology, Inc., the assignee of the present invention. Such applianceshave a thin shell of elastic material that generally conforms to apatient's teeth but is slightly out of alignment with an initial orimmediately prior tooth configuration. Placement of the elasticpositioner over the teeth applies controlled forces in specificlocations to gradually move the teeth into the new configuration.Repetition of this process with successive appliances comprising newconfigurations eventually moves the teeth through a series ofintermediate configurations or alignment patterns to a final desiredconfiguration. A full description of an exemplary elastic polymericpositioning appliance is described in U.S. Pat. No. 5,975,893, and inpublished PCT application WO 98/58596, and the content of thesedocuments are incorporated by reference for all purposes. The applianceis effective in receiving teeth when it is placed over the patient'steeth. Removal of the appliance for any reason may interrupt thetreatment plan and lengthen the overall period of treatment. Therefore,removal of the appliance should be minimized for effective and timelytreatment in some embodiments. However, a number of dental andperiodontal therapies which may be desired or required by the patientmay not be effectively utilized while the appliance is in place. Suchtherapies may be prescribed by a practitioner to improve oral health orthey may be requested by the patient for cosmetic purposes.

The '382 patent discloses devices, systems and methods for orthodontictreatment using elastic receiving appliances while concurrentlyproviding dental and periodontal therapies. Such therapies aretraditionally provided with the use of a variety of accessories anddevices which are applied when the receiving appliance is removed fromthe patient's mouth. The '382 system eliminates the need for suchremoval and additional devices by incorporating these therapies into thereceiving appliance. United States Patent Application 20040115587, thecontent of which is incorporated herewith by reference, discloses anorthodontic treatment involving applying force to receive teeth andadministering a tissue remodeling and/or an angiogenic substance(s) tothe periodontal tissue surrounding the teeth to be moved.

As noted in commonly owned U.S. Pat. No. 8,439,674 entitled “Systems andMethods for Intra-oral Drug Delivery,” the content of which isincorporated herein by reference, the receiving of teeth may beaccomplished with the use of a series of removable elastic positioningappliances such as the Invisalign® system available from AlignTechnology, Inc., the assignee of the present invention. The '674 patentdiscloses systems and methods for intraoral delivery of drugs from atleast one of the previously disclosed removable elastic positioningappliances.

In some aspects of the embodiments, the tooth receiving appliance isformed with an integrated reservoir using any of the direct fabricationmethods described herein. A reservoir is integrally formed into theappliance during a single manufacturing step whereby the reservoir isfabricated into the aligner shell. In this case, the reservoir isencompassed within the walls of the aligner shell, e.g., between aninternal surface of a wall near the teeth and an external surface of awall away from the teeth. Often the integrally formed reservoircomprises volume within the shell less than the volume of the shell inthe absence of the reservoir. Accordingly, the volume of the integrallyformed reservoir may be a portion of the volume of the shell in theabsence of the reservoir, for example, expressed as a ratio ofintegrally formed reservoir volume to shell volume. The appliancesdescribed herein are not limited to a single integrally formed reservoirand any description of an integrally formed reservoir herein may beapplicable to a plurality of integrally formed reservoirs within theshell (e.g., two, three, four, five, six, seven, eight, nine, ten, ormore reservoirs within the single shell). The integrally formedreservoir may have any of the geometries described herein, andintegrally formed reservoir geometries may be selected in accordancewith the patient treatment plan. Such geometries may be determinedduring the methods described herein. Features and characteristics of theintegrally formed reservoir are described further herein.

FIG. 3C illustrates a tooth receiving appliance 112 comprising a shell120 with an integrally formed reservoir 125. The tooth receivingappliance 112 is a portion of the tooth receiving system 150. Any of theappliances described herein can be designed and/or provided as part of aset of a plurality of appliances used in a tooth receiving system 150.The reservoir may be integrally formed in any position within the shellof the appliance such that release of an agent from the reservoir isperformed in accordance with the patient's treatment plan. Placement ofthe reservoir within the shell may be designed as a part of thepatient's treatment plan so as to not interfere with the intermediate orfinal tooth arrangement intended for the appliance. For example, thetooth receiving system 150 can include a first appliance 112corresponding to an initial tooth arrangement with a reservoirintegrally formed within the shell of the appliance at a first location,one or more intermediate appliances 121 corresponding to one or moreintermediate arrangements and each of the one or more intermediateappliances with a reservoir integrally formed within the shell of theappliance at a location different or the same from the first locationwithin the shell of the first appliance 112, and a final appliance 122with a reservoir integrally formed within the shell of the appliance ata location different from the first location or the same as the firstlocation and the one or more intermediate locations corresponding to atarget arrangement. An exemplary, but not limiting, location of theintegrally formed reservoir 125 is depicted in the final appliance 122.A target tooth arrangement can be any planned resulting arrangement forthe patient's teeth that follows one or more incremental receivingstages. Likewise, an initial tooth arrangement can be any initialarrangement for the patient's teeth that is followed by one or moreincremental receiving stages.

Any appliance for use at one or more of the incremental receiving stagesof the tooth receiving system may include an integrally formedreservoir. Design of a tooth receiving system can include but is notlimited to, planning a placement of the integrally formed reservoirwithin any of the appliances of the tooth receiving system used duringone or more of the incremental receiving stages, planning the number ofappliances to comprise an integrally formed reservoir for use during oneor more of the incremental receiving stages, planning the order of useof appliances comprising an integrally formed reservoir and the like.

In some aspects of the embodiments, the integrally formed reservoir mayhave any of a plurality of geometries including shapes, dimensions,angles and the like. Shapes of the integrally formed reservoir include,but are not limited to, a circle, an oval, an ellipse, a curvedstructure with a complex shape, a triangle, a square, a rectangle, apolygon, a pentagon, a hexagon, a heptagon, and the like. The integrallyformed reservoir may have walls which are straight or curved, as such,the walls of the integrally formed reservoir may or may not form angles.Geometries of the integrally formed reservoir may distribute through asingle plane (e.g., x-axis, y-axis, z-axis) of the shell or maydistribute through a plurality of planes through the aligner shell. Insome aspects, the reservoir can be contained wholly within the interiorof the shell such that no portion is directly exposed to the intraoralenvironment. In some other aspects, the reservoir can be partiallycontained within the interior such that one or more portions aredirectly exposed to the intraoral environment.

The dimensions of the integrally formed reservoir accord with the shapeof the integrally formed reservoir, the integrally formed reservoir mayhave a volume such that the integrally formed reservoir may be filledthrough the inlet port with an agent comprising a drug and an aqueoussolution as described herein. In some cases, the volume is devoid andempty such that the integrally formed reservoir may be filled throughthe inlet port with an agent comprising a drug and an aqueous solutionas described herein. In other cases, the volume comprises a firstmaterial, a second material and/or a third material wherein the first,second and/or third material is a porous material and/or a biodegradablematerial as described herein. Such dimensions may be expressed in aplurality of planes, including for example, but not limited to, x, y andz. As described herein, the integrally formed reservoir may comprise aplurality of volumes relative to the volume of the shell in the absenceof the integrally formed reservoir. The units of volumetric measurementfor the integrally formed reservoir may be cubic femtometers,picometers, nanometers, micrometers, millimeters, centimeters or thelike.

The agent can be any of the agents as described herein or known to oneof ordinary skill in the art. Exemplary agents include, but are notlimited to, drugs, chemicals, genes, polypeptides, enzymes and the like.Agents may be in an active form or in a pre-form. For example, apre-form agent, such as a pre-form enzyme, may be inactive towards thetarget and following interaction with another agent, often an enzymesuch as salivary amylase, the pre-form of the inactive enzyme isdigested into the active form of the enzyme. In some aspects, the agentis a medical grade drug, chemical agent, or a bioactive agent. Examplesof the drug or agent can include antibacterials, antibiotics,anti-inflammatory agents, immune-suppressive agents, immune-stimulatoryagents, dentinal desensitizers, odor masking agents, immune reagents,anesthetics, nutritional agents, antioxidants, lipopolysaccharidecomplexing agents, and peroxides, among others.

In some aspects, agents may be compounded with a pharmaceuticallyacceptable salt, for example, any salt (e.g., obtained by reaction withan acid or a base) of a composition of the present invention that isphysiologically tolerated in the target subject. “Salts” of thecompositions of the present invention may be derived from inorganic ororganic acids and bases. Examples of acids include, but are not limitedto, hydrochloric, hydrobromic, sulfuric, nitric, perchloric, fumaric,maleic, phosphoric, glycolic, lactic, salicylic, succinic,toluene-p-sulfonic, tartaric, acetic, citric, methanesulfonic,ethanesulfonic, formic, benzoic, malonic, sulfonic,naphthalene-2-sulfonic, benzenesulfonic acid, and the like. Other acids,such as oxalic, while not in themselves pharmaceutically acceptable, maybe employed in the preparation of salts useful as intermediates inobtaining the compositions of the invention and their pharmaceuticallyacceptable acid addition salts. Examples of bases include, but are notlimited to, alkali metal (e.g., sodium) hydroxides, alkaline earth metal(e.g., magnesium) hydroxides, ammonia, and compounds of formula NW₄ ⁺,wherein W is C_(M) alkyl, and the like.

Examples of salts include, but are not limited to: acetate, adipate,alginate, aspartate, benzoate, benzenesulfonate, bisulfate, butyrate,citrate, camphorate, camphorsulfonate, cyclopentanepropionate,digluconate, dodecylsulfate, ethanesulfonate, fumarate, flucoheptanoate,glycerophosphate, hemisulfate, heptanoate, hexanoate, chloride, bromide,iodide, 2-hydroxyethanesulfonate, lactate, maleate, methanesulfonate,2-naphthalenesulfonate, nicotinate, oxalate, palmoate, pectinate,persulfate, phenylpropionate, picrate, pivalate, propionate, succinate,tartrate, thiocyanate, tosylate, undecanoate, and the like. Otherexamples of salts include anions of the compounds of the presentinvention compounded with a suitable cation such as Na⁺, NH₄ ⁺, and NW₄⁺ (wherein W is a C₁^alkyl group), and the like. For therapeutic use,salts of the compounds of the present invention are contemplated asbeing pharmaceutically acceptable. However, salts of acids and basesthat are non-pharmaceutically acceptable may also find use, for example,in the preparation or purification of a pharmaceutically acceptablecompound.

In some aspects, agents may be a nucleic acid molecule, for example, anynucleic acid containing molecule, including but not limited to, DNA orRNA. The term encompasses sequences that include any of the known baseanalogs of DNA and RNA including, but not limited to, 4-acetylcytosine,8-hydroxy-N6-methyladenosine, aziridinylcytosine, pseudoisocytosine,5-(carboxyhydroxylmethyl) uracil, 5-fluorouracil, 5-bromouracil,5-carboxymethylaminomethyl-2-thiouracil,5-carboxymethylaminomethyluracil, dihydrouracil, inosine,N6-isopentenyladenine, 1-methyladenine, 1-methylpseudouracil,1-methylguanine, 1-methylinosine, 2,2-dimethylguanine, 2-methyladenine,2-methylguanine, 3-methylcytosine, 5-methylcytosine, N6-methyladenine,7-methylguanine, 5-methylaminomethyluracil,5-methoxyaminomethyl-2-thiouracil, beta-D-mannosylqueosine,5′-methoxycarbonylmethyluracil, 5-methoxyuracil,2-methylthio-N6-isopentenyladenine, uracil-5-oxyacetic acid methylester,uracil-5-oxyacetic acid, oxybutoxosine, pseudouracil, queosine,2-thiocytosine, 5-methyl-2-thiouracil, 2-thiouracil, 4-thiouracil,5-methyluracil, N-uracil-5-oxyacetic acid methylester,uracil-5-oxyacetic acid, pseudouracil, queosine, 2-thiocytosine, and2,6-diaminopurine.

In some aspects, agents may be a gene, for example, a nucleic acid(e.g., DNA) sequence that comprises coding sequences necessary for theproduction of a polypeptide, precursor, or RNA (e.g., rRNA, tRNA). Thepolypeptide can be encoded by a full length coding sequence or by anyportion of the coding sequence so long as the desired activity orfunctional properties (e.g., enzymatic activity, ligand binding, signaltransduction, immunogenicity, etc.) of the full-length or fragment areretained. The term also encompasses the coding region of a structuralgene and the sequences located adjacent to the coding region on both the5′ and 3′ ends for a distance of about 1 kb or more on either end suchthat the gene corresponds to the length of the full-length mRNA.Sequences located 5′ of the coding region and present on the mRNA arereferred to as 5′ non-translated sequences. Sequences located 3′ ordownstream of the coding region and present on the mRNA are referred toas 3′ non-translated sequences. The term “gene” encompasses both cDNAand genomic forms of a gene. A genomic form or clone of a gene containsthe coding region interrupted with non-coding sequences termed “introns”or “intervening regions” or “intervening sequences.” Introns aresegments of a gene that are transcribed into nuclear RNA (linRNA);introns may contain regulatory elements such as enhancers. Introns areremoved or “spliced out” from the nuclear or primary transcript; intronstherefore are absent in the messenger RNA (mRNA) transcript. The mRNAfunctions during translation to specify the sequence or order of aminoacids in a nascent polypeptide.

The agent may be present in or on a carrier or binder and/or whichcreates a matrix from which the agent can be released by diffusion ordissolution. In some cases, the agent is dissolved in the carrier orbinder. In this case, the agent may be provided in powder or similarform and dissolved in a liquid solvent. The result may be a solutionwhich may be filled into the integrally formed reservoir through theinlet and/or universal port. When the repositioning appliance is placedover the patient's teeth, the agent may be released from the integrallyformed reservoir as described herein. Release may be due to activationor deactivation of the carrier or any other releasing mechanism, such asby enzymes or proteins in saliva. Or release may be due to degradationof the carrier by contact with, for example, saliva. It may beappreciated that any agent, particularly fluoride materials,antibiotics, bleaching materials and breath fresheners, may be deliveredto the oral environment in this manner.

In some cases, the carrier or a material comprising at least a portionof the integrally formed reservoir is degradable (e.g., dissolvable,biodegradable, and the like). For example, the second material, thethird material and additional other materials as described herein may bedegradable materials. Degradable materials for use in the systems,methods and appliances as described herein are known to those ofordinary skill in the art. Degradable materials as disclosed herein areexemplary and the systems, methods and appliances as described hereinmay be used in combination with any degradable material known to one ofordinary skill in the art. While not limiting, properties of degradablematerials include the following examples, such as absorption of aqueoussolutions (e.g., saliva, water and the like), adsorption of aqueoussolutions (e.g., saliva, water and the like), pH and/or changes in pH,temperature and/or changes in temperature, enzymatic sensitivity whereinsensitivity includes the degradable material comprising enzymaticsubstrates, mechanical disruption and/or stimulation, electrical and/orstimulation, sonic and/or stimulation and any other methods ofdegradation known to one of ordinary skill in the art.

The degradation products often define the biocompatibility of a polymer.Synthetic biodegradable polymers are favored over natural ones becauseof reliability of raw materials. In some aspects, the degradablematerial may be, but is not limited to, polyglycolide (PGA), polylactide(PLA), l-lactide (LPLA), poly(dl-lactide) (DLPLA), poly(caprolactone)(PCL), polydioxanone (PDO), poly(glycolide-co-trimethylene carbonate)(PGA-TMC), and polyorthoesters.

In some aspects, the material can comprise and/or the integrally formedreservoir may comprise an enzyme or a reactor that reacts with enzymesfrom the oral fluids. When oral fluids or enzyme from the oral fluidsenters the well, the material reacts with the enzyme to provide anindication. Alternatively, a pH indicator can be used as the material.In yet another embodiment, the membrane can be silicon instead of PVS.

In another aspect, the polymer can be water-soluble polymer thatincludes water-soluble polymers, lightly cross-linked hydrogels, andhigh molecular weight with hydrogen bonding plastics that demonstratesome limited water resistance. Natural-based water-soluble polymersinclude starch, starch-oxided, cellulose, cellulose-alkoxylated,cellulose-carboxyalkylated, chitin, chitosan, pectins, hyaluronic acid,proteins, and lignin. Water-soluble polymers can also be created fromsynthetic raw material through polymerization by addition/vinyl,condensation, and ring-opening. Examples of these types of polymers arepoly(vinyl alcohol), polyesters, and poly(alkylene oxides). Thehydrolytic instability of biodegradable polymers is advantageous becausethe presence of the oral fluids will facilitate the degradation of thepolymer.

In some aspects, the tooth receiving appliance is comprised of amaterial as disclosed herein. The integrally formed reservoir may beformed from the same material as the shell of the tooth receivingappliance. FIG. 3D illustrates a tooth receiving appliance 126comprising a shell 127 with an integrally formed reservoir 128, theshell 127 of the tooth receiving appliance 126 fabricated from a firstmaterial and the integrally formed reservoir fabricated from the firstmaterial. Any of the appliances described herein can be designed and/orprovided as part of a set of a plurality of appliances used in a toothreceiving system 150. In some cases, the material comprising theintegrally formed reservoir may comprise a different porosity than thematerial comprising the shell. Often the integrally formed reservoir maycomprise porous and non-porous material. For example, the integrallyformed reservoir may be directly fabricated with the first materialcomprising pores. The diameter of the pores may be, but is not limitedto, about 50 μm, about 30 μm, about 25 μm, about 20 μm, about 15 μm,about 10 μm, about 5 μm, about 1 μm, about 500 nm, about 100 nm, about10 nm, or about 1 nm. In some cases, the pores of the materialcomprising a portion of the integrally formed reservoir may be the samesize or different sizes. The porous properties of a material can be usedas a method of controlling diffusion of an agent from the integrallyformed reservoir. For example, larger pores, such as 50 μm may beselected as the diameter of the pores in the porous material when theagent is of a small molecular weight, thus the porous material isconfigured for a higher rate of diffusion of the agent through the poresand into the intraoral cavity. As another example, medium-sized pores,such as 25 μm may be selected as the diameter of the pores in the porousmaterial when the agent is of a small molecular weight, thus the porousmaterial is configured for a medium rate of diffusion of the agentthrough the pores and into the intraoral cavity. The plurality of agentsdescribed herein or others known to one of skill in the art can comprisea plurality of molecular weights. The pore sizes described herein orothers known to one of ordinary skill in the art of the porous materialcan be selected during the methods of manufacturing and/or fabricatingthe shell in order to facilitate a desired rate of delivery and/ordesired rate of diffusion of the agent from the integrally formedreservoir. The first material may be selected from a material asdescribed herein or known to one of ordinary skill in the art and often,but is not limited to, lacking degradable properties.

FIG. 3E illustrates a tooth receiving appliance 129 comprising a shell130 with an integrally formed reservoir 131, the shell 130 of the toothreceiving appliance 129 fabricated from a first material and theintegrally formed reservoir fabricated from a second different material.Any of the appliances described herein can be designed and/or providedas part of a set of a plurality of appliances used in a tooth receivingsystem 150. In some cases, the second material comprising the integrallyformed reservoir may comprise a different porosity than the materialcomprising the shell. Often the integrally formed reservoir may compriseporous and non-porous portions of the second material. For example, theintegrally formed reservoir may be directly fabricated with the secondmaterial comprising pores. The diameter of the pores may be, but is notlimited to, about 50 μm, about 30 μm, about 20 μm, about 15 μm, about 10μm, about 5 μm, about 1 μm, about 500 nm, about 100 nm, about 10 nm, orabout 1 nm. In some cases, the pores of the material comprising aportion of the integrally formed reservoir may be the same size ordifferent sizes. The first material may be selected from a material asdescribed herein or known to one of ordinary skill in the art and often,but is not limited to, lacking degradable properties. The secondmaterial may be selected from a material as described herein or known toone of ordinary skill in the art and often, but is not limited to, is adegradable material.

FIG. 3F illustrates a tooth receiving appliance 132 comprising a shell133 with an integrally formed reservoir 134, the shell 133 of the toothreceiving appliance 132 fabricated from a first material. A portion ofthe integrally formed reservoir is fabricated from the first materialand a portion of the integrally formed reservoir fabricated from asecond different material. Any of the appliances described herein can bedesigned and/or provided as part of a set of a plurality of appliancesused in a tooth receiving system 150. In some cases, the second materialcomprising the integrally formed reservoir may comprise a differentporosity than the material comprising the shell. Often the integrallyformed reservoir may comprise porous and non-porous portions of thesecond material. For example, the integrally formed reservoir may bedirectly fabricated with the second material comprising pores. Thediameter of the pores may be, but is not limited to, about 50 μm, about30 μm, about 20 μm, about 15 μm, about 10 μm, about 5 μm, about 1 μm,about 500 nm, about 100 nm, about 10 nm, or about 1 nm. In some cases,the pores of the material comprising a portion of the integrally formedreservoir may be the same size or different sizes. The first materialmay be selected from a material as described herein or known to one ofordinary skill in the art and often, but is not limited to, lackingdegradable properties. The second material may be selected from amaterial as described herein or known to one of ordinary skill in theart and often, but is not limited to, is a degradable material.

In some aspects of the embodiments described herein, a rate controllingmembrane is disposed over the integrally formed reservoir and controlsthe rate at which the substance is released from the integrally formedreservoir. FIG. 3G illustrates a cross-section view of a shell 151 andan integrally formed reservoir 152 comprising a rate controllingmembrane 153, the shell positioned around a tooth 154. The ratecontrolling membrane 153 may be disposed over a portion of a wall of theintegrally formed reservoir, over a portion of a plurality of walls ormay form a wall of the integrally formed reservoir. The depiction hereinof the rate controlling membrane 153 as forming a wall of the integrallyformed reservoir is exemplary and not intended to limit the relativesize of the rate controlling membrane or the position of the ratecontrolling membrane that may be used in aspects of the embodimentsdescribed herein. The rate controlling membrane 153 may include pores tocontrol release of an agent from the reservoir 152. The diameter of thepores may be, but is not limited to, about 50 μm, about 30 μm, about 20μm, about 15 μm, about 10 μm, about 5 μm, about 1 μm, about 500 nm,about 100 nm, about 10 nm, or about 1 nm. In some cases, the pores ofthe rate controlling membrane 153 may be the same size or differentsizes. The rate controlling membrane may be formed from a material asdescribed herein or known to one of ordinary skill in the art and often,but is not limited to, includes a degradable material.

The reservoir may be pre-filled or preloaded with an agent or substancefor delivery. In this case, the appliance may be ready for insertion oruse upon removal from any packaging without the need of loading theappliance with the agent for delivery. If the releasing means isdesigned for a single delivery period, the appliance may be wornthroughout the prescribed repositioning period and then disposed of. Ifthe releasing means is designed for multiple delivery periods, thereservoir may be replenished with the agent to be released any number oftimes throughout the prescribed repositioning period. It may beappreciated that any agent, particularly fluoride materials,antibiotics, bleaching materials and breath fresheners, may be deliveredto the oral environment in this manner.

FIG. 3H illustrates a tooth receiving appliance 135 comprising a shell136 with an integrally formed reservoir 137, the shell 136 of the toothreceiving appliance 135 fabricated from a first material. A portion ofthe integrally formed reservoir can be fabricated from a second materialand a portion of the integrally formed reservoir can be fabricated froma third material. Any of the appliances described herein can be designedand/or provided as part of a set of a plurality of appliances used in atooth receiving system 150. The first material may be selected from amaterial as described herein or known to one of ordinary skill in theart and often, but is not limited to, lacking degradable properties. Thesecond material may be selected from a material as described herein orknown to one of ordinary skill in the art and often, but is not limitedto, is a degradable material. The third material may be selected from amaterial as described herein or known to one of ordinary skill in theart and often, but is not limited to, is a degradable material.

Kinetics of agent release may be affected by the material and otherfeatures of the tooth receiving appliance. For example, the materialcomprising the shell may affect the response of the shell to a stimulus.Features of the material that may affect the response to the stimulusinclude the polymer length, crosslinking, presence of other moleculeswithin the polymers of the shell, flexibility of the shell under variousconditions (e.g., temperature changes, pH changes). Additional featureswhich may affect agent release kinetics may include, but are not limitedto, the pharmaceutical carrier, the tooth receiving appliance geometry,stimulus, materials comprising the reservoir, pores within the materialscomprising the reservoir, mechanism of biodegradation, etc.

Flexible shape change from a first shape where the agent is storedwithin the reservoir and the port (e.g., outlet or universal port) is ina closed position, to a second shape formed in response to a stimulus(e.g., pressure, pH, temperature, and other stimuli described herein orknown to a person of ordinary skill in the art) to the tooth receivingappliance, the stimulus inducing opening of the port (e.g., outlet oruniversal), the agent stored within the reservoir is released from thereservoir through the port, and then to a third shape when the stimulusis removed from the tooth receiving appliance, the port returns to aclosed position and the reservoir contains less agent in the third shapethan the reservoir contained in the first shape. Stimulus-inducedrelease of the agent stored within the reservoir in the second shape mayinduce release of various amounts of the agent stored within thereservoir. For example, the stimulus may induce release of the entiretyof the agent stored within the reservoir or a portion of the agentstored within the reservoir. The amount of agent released may beaffected by various factors, including but not limited to, the amount ordegree of stimulus (e.g., magnitude of pressure, change in pH, change intemperature, or other amounts or degrees known to a person of ordinaryskill in the art), the duration of the stimulus (e.g., amount of timethe stimulus is applied), the size of the port, whether the port isconnected to a channel and the structure of the channel (e.g., straight,curved, multiples of various planes), the pharmaceutical carrier inwhich the agent is compounded, the viscosity and/or density of thecarrier, kinetics of the agent or other factors known to a person ofordinary skill in the art.

In some aspects of the embodiments, the integrally formed reservoir maybe located in a plurality of positions within the aligner shell. Thelocation of the integrally formed reservoir may be determined during themethods of planning a patient's treatment plan, during the fabricationstep or any other method described herein. In some cases, the placementof the integrally formed reservoir depends upon the agent to be releasedfrom the integrally formed reservoir, such agents as discussed herein orknown to one of ordinary skill in the art. In some cases, the placementof the integrally formed reservoir depends upon the material from whichthe formed reservoir is comprised, such materials as discussed herein orknown to one of ordinary skill in the art. In some aspects, the shellcan contain one or more walls defining teeth receiving cavities(occlusal, buccal, and/or lingual walls) and the reservoir can be formedpartially or wholly within the wall(s). The plurality of positions mayinclude, but is not limited to, the lingual surface, the occlusalsurface, the buccal surface, the gingival portion, the interior surface(e.g., near the received teeth), the exterior surface (e.g., away fromthe received teeth), the anterior portion, the posterior portion, thedistal portion, the mesial portion or the like, or combinations thereof.The integrally formed reservoir may be positioned such that the longestaxis of the integrally formed reservoir aligns with or does not alignwith the mesial-distal axis of the shell. The integrally formedreservoir may be positioned such that the longest axis of the integrallyformed reservoir aligns with or does not align with theposterior-anterior axis of the shell. The integrally formed reservoirmay be positioned such that the longest axis of the integrally formedreservoir aligns with or does not align with the posterior-anterior axisof the shell. The integrally formed reservoir may be positioned suchthat the longest axis of the integrally formed reservoir aligns with ordoes not align with the vertical axis of the shell. In some aspects, ashell can contain one or more walls defining teeth receiving cavities(occlusal, buccal, and/or lingual walls) and the reservoir can be formedpartially or wholly within the wall(s). In some aspects, placement ofthe reservoir within the shell, as described herein, may affect theresponse of the shell to the stimulus. For example, the reservoir can bepositioned near an area of the intraoral cavity where localized drugdelivery is desired.

Some embodiments described herein include an aligner shell comprising anintegrally formed reservoir configured to receive, store and release anagent. In some cases, the aligner may be supplied to the patient withthe integrally formed reservoir prefilled with the agent. In othercases, the aligner may be supplied to the patient without the agentprefilled into integrally formed reservoir. In such cases, the reservoiris filled with the agent at some time point after receipt of thealigner. In any of the previous cases, the integrally formed reservoirmay be refilled with an agent, either the same agent as the aligner wassupplied with or a different agent, following application of theappliance to the patient's teeth. Any of the agents described herein maybe prefilled, filled following receipt or refilled into the integrallyformed reservoir of the aligner shell.

In some cases, the patient can wear each appliance until the agentstored within the reservoir of each appliance on the teeth has beenexpelled such that the reservoir no longer contains an effective amountof the agent or until the optional tooth movement can no longer be feltor until the maximum amount of expressed tooth movement for that givenstage has been achieved. As described further herein, the reservoir maybe filled with an agent prior to the patient receiving the appliance, orthe reservoir may require filling with an agent after the patientreceives the appliance. In some cases, the agent may be refilled intothe reservoir during the course of treatment with said appliance. Aplurality of different appliances (e.g., a set) can be designed and evenfabricated prior to the patient wearing any appliance of the plurality.

In some embodiments, a polymeric shell appliance can be formed from asheet of multiple suitable layers of polymeric material. For example,FIG. 3A shows a portion of a dental appliance 300 formed from amulti-layer polymer sheet, in accordance with an embodiment. Sometimesduring orthodontic treatment, it may be necessary to apply forces to atooth to generate movement of the tooth to, for example, bring thepatient's teeth into a better occlusion in a mesial or distal direction.Multilayer aligners can, for example, provide increased durability ofthe aligners so that they can better withstand wear due to alignerreinsertion and removal and other mechanical stresses put on the alignerduring treatment. In addition, multi-layer aligners have improvedelastic properties that allow for less degradation in the shape of theteeth receiving cavities during a stage of treatment.

As noted above, an embodiment utilizes a multilayer sheet for use in adental appliance. The multilayer sheet can include three layers, inwhich a hard polymer layer is disposed between two soft polymer layers.The sheet can include a hard polymer layer disposed between at least onefirst soft polymer layer and at least one second soft polymer layer. Themultilayer sheets can be used in making dental aligners having improveddurability for use, e.g., to the elastic properties of the multilayersheet when formed into an aligner. In addition, the bonding strengthbetween the layers further improves the durability of the aligners, forexample, by withstanding teeth grinding by a patient.

According to the embodiment illustrated in FIGS. 3A and 3B, theappliance 300 is formed from a sheet 330 including multiple layers ofpolymeric material. As will be explained in more detail below, eachlayer can have its own associated color property such that directingcertain types of energy at portions of the appliance 300 extracts andreveals the associated color in those portions. An etching device (e.g.,laser or milling tool), heat, or other energy can be used to extract thecolor properties associated with each layer.

FIG. 3B is a side cross-sectional view of a multi-layer sheet 330 thatcan be used to make the multi-layer dental appliance 300. As shown, amulti-layer sheet 330 can include a three layer structure: a hardpolymer layer 334 and two soft polymer layers 332, 336. The hard polymerlayer 334 can be positioned between a first soft polymer layer 332 and asecond soft polymer layer 336, as shown in FIG. 3B. In some embodiments,the hard polymer layer can be thicker than either of the soft polymerlayers. The soft polymer layers can have the same or differentthicknesses. For example, the hard polymer layer can have a thickness ina range from about 400 μm to about 1100 μm, about 450 μm to about 1000μm, about 500 μm to about 900 μm, or about 550 μm to about 750 μm. Thesoft polymer layers can have a thickness in a range from about 25 μm toabout 100 μm, about 30 μm to about 90 μm, or about 35 μm to about 80 μm.Multilayer sheets used for making appliances having a hard polymer layerdisposed between two soft polymer layers can range from a thickness ofabout 500 μm to about 1200 μm, about 550 μm to about 1100 μm, or about600 μm to about 1000 μm. In some embodiments, the thicknesses of thevarious layers can be tailored for a particular stage of treatment forthe patient.

Suitable polymeric materials for the hard polymer layer can include apolyester, a co-polyester, a polycarbonate, a thermoplasticpolyurethane, a polypropylene, a polyethylene, a polypropylene andpolyethylene copolymer, an acrylic, a cyclic block copolymer, apolyetheretherketone, a polyamide, a polyethylene terephthalate, apolybutylene terephthalate, a polyetherimide, a polyethersulfone, apolytrimethylene terephthalate or a combination thereof (e.g., a blendof at least two of the listed hard polymeric materials). In someembodiments, the hard polymer layer of the appliances can includepolymeric materials, such as a polycarbonate, a co-polyester, apolyester, and a thermoplastic polyurethane. In some embodiments, thehard layer can be composed of multiple hard layers, e.g., two or threehard polymer layers co-extruded to form one hard layer. According to anembodiment, a thicker polymer layer includes multiple layers withvarying properties and color elements, and a thinner layer is a clearcoat(s) over the thicker layer.

Suitable polymeric materials for the soft polymer layers 332, 336 of theappliance 300 can include a styrenic block copolymer (SBC), a siliconerubber, an elastomeric alloy, a thermoplastic elastomer (TPE), athermoplastic vulcanizate (TPV) elastomer, a polyurethane elastomer, ablock copolymer elastomer, a polyolefin blend elastomer, a thermoplasticco-polyester elastomer, a thermoplastic polyamide elastomer, or acombination thereof (e.g., a blend of at least two of the listed softpolymeric materials). The soft polymer layers 332, 336 can either be thesame material or different materials. In certain embodiments, the firstsoft polymer layer 332 and the second soft polymer layer 336 are thesame polymeric material.

As described herein, the multi-layer sheet can include a hard polymerlayer disposed between two soft polymer layers. In one embodiment, themultilayer appliance 300 can include a hard polymer layer of one type ofmaterial (e.g., a co-polyester), and two soft polymer layers of othertypes of material that can be the same or different (e.g., two softpolymer layers of thermoplastic polyurethane elastomer). In someembodiments, the multilayer appliances can also include a hard polymerlayer of at least two layers of polymer material. For example, the hardpolymer layer can include several polymer layers laminated together toform the hard polymer layer. The laminated hard polymer layer caninclude at least two layers of any combination of the following polymermaterials: a polyester, a co-polyester, a polycarbonate, a thermoplasticpolyurethane, a polypropylene, a polyethylene, a polypropylene andpolyethylene copolymer, an acrylic, a cyclic block copolymer, apolyetheretherketone, a polyamide, a polyethylene terephthalate, apolybutylene terephthalate, a polyetherimide, a polyethersulfone, and apolytrimethylene terephthalate. Similarly, in some embodiments, themultilayer appliances can include a soft polymer layer of at least twolayers of polymer material. For example, the soft polymer layers caninclude a layer of several polymer layers laminated together. Thelaminated soft polymer layers can include at least two layers of anycombination of the following polymer materials: a styrenic blockcopolymer (SBC), a silicone rubber, an elastomeric alloy, athermoplastic elastomer (TPE), a thermoplastic vulcanizate (TPV)elastomer, a polyurethane elastomer, a block copolymer elastomer, apolyolefin blend elastomer, a thermoplastic co-polyester elastomer, anda thermoplastic polyamide elastomer.

As shown in FIG. 3B, each of the soft and hard polymer layers can beformed from more than one layer or a thermal set. The first soft polymerlayer 332 can be formed from three layers 332 a, 332 b, 332 c of a softpolymer material. Similarly, the second soft polymer layer 336 can beformed from three layers 336 a, 336 b, 336 c of either the same or adifferent soft polymer material. In the illustrated embodiment, the hardpolymer layer 334 is also formed from three layers 334 a, 334 b, 334 cof a hard polymer material. It will be understood that, in otherembodiments, the polymer layers 332, 334, 336 can be formed from more orfewer layers. For example, the first polymer layer 332 could be formedfrom a single layer of a soft polymer material in one embodiment,whereas in another embodiment, the first polymer layer 332 is formedfrom five layers of a soft polymer material.

Each of the different layers in the appliance 300 can be associated witha different color such that when a particular layer of the appliance 300is exposed, its associated color is also revealed in the exposed area.An example will be described below with reference to FIGS. 3A and 3B. Asshown in FIG. 3A, in the illustrated embodiment, the ornamental design310 has nine different sections 320 a-320 i, each having a differentcolor. The color of each of the nine sections 320 a-320 i is determinedby the associated layer that is exposed. For example, the top-most layer332 a could be red in this example. If the appliance 300 is fabricatedand it does not have an intended ornamental design, the appliance 300could be left as is and the entire appliance 300 could be red.

However, if an ornamental design 310 on the appliance 300 is desired,certain layers in certain portions could be removed to form the design310. For example, section 320 a could be associated with the top-mostlayer 332 a, and therefore section 320 a would be red in this example.Section 320 b could be associated with the next layer 332 b, which isorange in this example. To make section 320 b orange, the portion of thelayer above (i.e., 332 a) in the area of section 320 b would be removedto expose layer 332 b in the area of section 320 b. The thickness of theappliance depends on the intended purpose of the appliance. For example,the appliance is generally thicker if the appliance is intended to moveteeth than if the appliance is intended to retain teeth or protect teeth(as a mouth guard). Typically, an orthodontic appliance has a thicknessin a range of about 250 μm-2 mm. Thus, layers can be removed in thedesign area to expose colored layers provided the thickness of theappliance in the area is at least about 250 μm.

According to another embodiment, an ornamental design 310 can be printedon one of the layers 332, 334, 336 before the multilayer polymer sheet330 is formed. In some embodiments, the design 310 can be an ink jetdesign, which adheres to the surface of the appliance 300. Themultilayer sheet 330 is then formed into a dental appliance bythermoforming, as described in more detail below with reference to FIGS.5 and 6. Alternatively, the appliance 300 can be formed by thermoformingone layer at a time. A design or portion of the design 310 can be etchedin each layer before the subsequent layer is thermoformed.

In yet another embodiment, colored pellets, ink, or dye can be includedin the material of the appliance 300 and light energy is used toactivate certain colors to form the design 310. The colored pellets,ink, or dye can be integrated with either a single layer polymer sheetor in a multilayer sheet. Laser energy directed at the areas of theappliance 300 at a particular wavelength reacts with the coloredpellets, ink, or dye to activate the colors. Laser marking of polymermaterial of the appliance 300 relies on carbonization or foamingprocesses caused by laser beam absorption. Carbonization, which is athermochemical process, produces dark marks, whereas foaming, which is apartial degradation creating gas-bubbles within the material, scattersthe light and produces light marks. Additives can help improveabsorption properties. Applicable laser sources are Nd: YAG-, Nd:Vanadate- or fiber lasers. Furthermore, harmonic wavelengths of 532 nm(green) and 355 nm (UV) can be used for bleaching and photo reductionprocesses. UV-induced photo reduction is often called “cold marking”, asthere is no noticeable heating of the material. Additives in plasticscan increase the diversity of colors produced by the laser process.

Permanent change thermochromic ink can be included in the polymericmaterial of the appliance 300, as it is a high temperature activated,permanent change ink or pigment. The permanent change thermochromic inkcan produce a gradual color change that becomes denser as thetemperature increases. Such permanent change thermochromic inks aremanufactured by LCR Hallcrest LLC of Glenview, Ill. Permanent changethermochromic inks are typically activated in the range of 60 to 200° C.Numerous custom colors and temperature activation points are availablefor these inks.

Multilayer sheets can provide a variety of improved properties foraligners used in orthodontic treatment. As further described herein, themultilayer sheets formed into aligners can, for example, provideincreased durability of the aligners so that they can better withstandwear due to teeth grinding and other mechanical stresses put on thealigner during treatment. In addition, the aligners have improvedelastic properties that allow for less degradation in the shape of theteeth receiving cavities during a stage of treatment. For example,during a multistage orthodontic treatment, the capability of an alignerto force tooth movement can degrade and may cause the treatment toinclude more aligners to reach a final ideal arrangement and/or resultin a mid-course correction that could be prevented by using alignerswith improved physical properties, such as those provided herein.

Yet another embodiment will be described with reference to FIGS. 4A and4B. FIGS. 4A and 4B show a dental appliance 400 that has aninterchangeable ornamental design 410 that can be mechanically attachedto the appliance 400.

In these embodiments, the mechanical attachment of the design 410 iscreated by first providing an indentation or recessed portion 420 on thefront surface of the appliance 400. The recessed portion 420 can have adepth in the range of about 50 μm-1 mm, depending on the type ofmechanical attachment. The ornamental design 410 can be attached to thefront surface of the appliance 400 in the recessed portion 420. In theembodiment shown in FIG. 4A, the appliance 400 has a simple recessedportion 420 in which to receive an ornamental design 410.

In the embodiment shown in FIG. 4B, the ornamental design 410 isinserted into a recessed portion and held in place by tabs 430 which areintegrally formed with the appliance 400. As shown in FIG. 4B, theornamental design 410 is shaped such that there is a fairly smoothtransition between the appliance 400 and the mechanically attachedornamental design 410 and that the design 410 is substantially flushwith the surface of the appliance 400 when the design 410 is insertedinto the recessed portion.

Attachment can be made by medical grade adhesive. For an ornamentaldesign 410 attached using medical grade adhesive, the recessed portion420 can have a depth in the range of about 50-100 μm to accommodate anadhesive sticker having about the same thickness. For an ornamentaldesign 410 that is rigid, the recessed portion 420 can have a depth inthe range of about 0.1-1 mm to accommodate the thickness of the rigidornamental design 410. As the ornamental design 410 is mechanicallyattached to the appliance 400, it can be changed as desired by thepatient. The ornamental design 410 does not affect the functionality ofthe appliance 400. However, the material of the ornamental design 410should have sufficient flexibility to be able to flex with the appliance400.

FIG. 5 depicts an example embodiment of a process 30 for forming adental appliance, in accordance with an embodiment. As shown, a polymersheet 32 can be formed into a tooth positioning appliance 36. In someembodiments, the polymer sheet 32 can be a multilayer sheet, such as themultilayer sheet 330 described above. As noted above, a multilayerpolymer sheet can a hard polymer layer disposed between two soft polymerlayers.

In this exemplary process, the dental appliance 36 can be produced withthe use of a physical tooth model, or mold, 34. The dental appliance 36can be produced by heating the thermoformable polymer sheet 32 and thenvacuum or pressure forming the sheet over the teeth in the physicaltooth model 34. The dental appliance 36 is a direct representation ofthe physical tooth model. Excess material from the sheet can be trimmedto form a final dental appliance that can be used for dental/orthodontictreatment of a patient.

One or a series of physical tooth models, such as the model describedabove, may be used in the generation of elastic repositioning appliancesfor orthodontic treatment. Similar to the process above, each of theappliances can be generated by thermoforming a polymeric material over amold of a desired tooth arrangement to form a dental appliance. Thetooth positioning appliance of the desired tooth arrangement generallyconforms to a patient's teeth, but is slightly out of alignment with theinitial tooth configuration. Placement of the elastic positioner overthe patient's teeth applies controlled forces in specific locations togradually move the teeth into the desired configuration. Repetition ofthis process with successive appliances comprising new configurationseventually moves the teeth through a series of intermediateconfigurations to a final desired configuration.

FIG. 6 shows a simple schematic for a method 600 of fabricating aremovable orthodontic tooth positioning appliance having teeth receivingcavities shaped to directly receive at least some of the patient's teethand apply a resilient positioning force to the patient's teeth, inaccordance with an embodiment. The method can include providing apolymer sheet, which can be a multilayer sheet having a hard polymerlayer disposed between two soft polymer layers in step 610. The methodcan further include providing a positive physical model of a patient'steeth in step 620. The tooth positioning appliance can be fabricated bythermoforming the polymer sheet over the positive physical model in step630, in which the tooth positioning appliance is a negative of thepositive model. As described above, the method 600 of fabrication canfurther include trimming or cutting portions of the sheet to render afinal, usable appliance for dental or orthodontic treatment.

Although fabricating an appliance by thermoforming is described withreference to FIGS. 5 and 6, it will be appreciated that a variety ofmethods can be used for fabricating the dental appliances describedherein. As noted above, the appliances can be fabricated bythermoforming, milling, 3D printing, stereolithography, casting, etc.Some embodiments of the orthodontic appliances herein (or portionsthereof) can be produced using direct fabrication, such as additivemanufacturing or rapid prototyping techniques. Layers and thickness canbe added to desired regions by printing, spraying, painting, and dippingthe aligner.

In many embodiments, stereolithography involves selective polymerizationof a photosensitive resin (e.g., photopolymer) according to a desiredcross-sectional shape using light (e.g., ultraviolet light). The objectgeometry can be built up in a layer-by-layer fashion by sequentiallypolymerizing a plurality of object cross-sections. As another example,the appliances herein can be fabricated using selective laser sintering.In many embodiments, selective laser sintering involves using a laserbeam to selectively melt and fuse a layer of powdered material accordingto a desired cross-sectional shape in order to build up the objectgeometry. As yet another example, the appliances herein can befabricated by fused deposition modeling. In many embodiments, fuseddeposition modeling involves melting and selectively depositing a thinfilament of thermoplastic polymer in a layer-by-layer manner in order toform an object. In yet another example, 3D printing can be used tofabricate the appliances herein. In many embodiments, 3D printinginvolves jetting or extruding one or more materials onto a build surfacein order to form successive layers of the object geometry. For example,a 3D printer can be used to print the ornamental design. One or morecolors can be printed on the appliance to form the design as theappliance is printed using a 3D printer.

In many embodiments, the direct fabrication methods provided hereinbuild up the object geometry in a layer-by-layer fashion, withsuccessive layers being formed in discrete build steps. Alternatively orin combination, direct fabrication methods that allow for continuousbuild-up of an object geometry can be used, referred to herein as“continuous direct fabrication.” Various types of continuous directfabrication methods can be used. As an example, in many embodiments, theappliances herein are fabricated using “continuous liquid interphaseprinting,” in which an object is continuously built up from a reservoirof photopolymerizable resin by forming a gradient of partially curedresin between the building surface of the object and apolymerization-inhibited “dead zone.” In many embodiments, asemi-permeable membrane is used to control transport of aphotopolymerization inhibitor (e.g., oxygen) into the dead zone in orderto form the polymerization gradient. Continuous liquid interphaseprinting can achieve fabrication speeds about 25 times to about 100times faster than other direct fabrication methods, and speeds about1000 times faster can be achieved with the incorporation of coolingsystems. Continuous liquid interphase printing is described in U.S.Patent Publication Nos. 2015/0097315, 2015/0097316, and 2015/0102532,the disclosures of each of which are incorporated herein by reference intheir entirety.

The various embodiments of the orthodontic appliances presented hereincan be fabricated in a wide variety of ways. In some embodiments, theorthodontic appliances herein (or portions thereof) can be producedusing direct fabrication, such as additive manufacturing techniques(also referred to herein as “3D printing”) or subtractive manufacturingtechniques (e.g., milling). In some embodiments, direct fabricationinvolves forming an object (e.g., an orthodontic appliance or a portionthereof) without using a physical template (e.g., mold, mask etc.) todefine the object geometry. Additive manufacturing techniques can becategorized as follows: (1) vat photopolymerization (e.g.,stereolithography), in which an object is constructed layer by layerfrom a vat of liquid photopolymer resin; (2) material jetting, in whichmaterial is jetted onto a build platform using either a continuous ordrop on demand (DOD) approach; (3) binder jetting, in which alternatinglayers of a build material (e.g., a powder-based material) and a bindingmaterial (e.g., a liquid binder) are deposited by a print head; (4)fused deposition modeling (FDM), in which material is drawn though anozzle, heated, and deposited layer by layer; (5) powder bed fusion,including but not limited to direct metal laser sintering (DMLS),electron beam melting (EBM), selective heat sintering (SHS), selectivelaser melting (SLM), and selective laser sintering (SLS); (6) sheetlamination, including but not limited to laminated object manufacturing(LOM) and ultrasonic additive manufacturing (UAM); and (7) directedenergy deposition, including but not limited to laser engineering netshaping, directed light fabrication, direct metal deposition, and 3Dlaser cladding. For example, stereolithography can be used to directlyfabricate one or more of the appliances herein. In some embodiments,stereolithography involves selective polymerization of a photosensitiveresin (e.g., a photopolymer) according to a desired cross-sectionalshape using light (e.g., ultraviolet light). The object geometry can bebuilt up in a layer-by-layer fashion by sequentially polymerizing aplurality of object cross-sections. As another example, the appliancesherein can be directly fabricated using selective laser sintering. Insome embodiments, selective laser sintering involves using a laser beamto selectively melt and fuse a layer of powdered material according to adesired cross-sectional shape in order to build up the object geometry.As yet another example, the appliances herein can be directly fabricatedby fused deposition modeling. In some embodiments, fused depositionmodeling involves melting and selectively depositing a thin filament ofthermoplastic polymer in a layer-by-layer manner in order to form anobject. In yet another example, material jetting can be used to directlyfabricate the appliances herein. In some embodiments, material jettinginvolves jetting or extruding one or more materials onto a build surfacein order to form successive layers of the object geometry.

As another example, a continuous direct fabrication method can achievecontinuous build-up of an object geometry by continuous movement of thebuild platform (e.g., along the vertical or Z-direction) during theirradiation phase, such that the hardening depth of the irradiatedphotopolymer is controlled by the movement speed. Accordingly,continuous polymerization of material on the build surface can beachieved. Such methods are described in U.S. Pat. No. 7,892,474, thedisclosure of which is incorporated herein by reference in its entirety.

In another example, a continuous direct fabrication method can involveextruding a composite material composed of a curable liquid materialsurrounding a solid strand. The composite material can be extruded alonga continuous three-dimensional path in order to form the object. Suchmethods are described in U.S. Patent Publication No. 2014/0061974, thedisclosure of which is incorporated herein by reference in its entirety.

In yet another example, a continuous direct fabrication method utilizesa “heliolithography” approach in which the liquid photopolymer is curedwith focused radiation while the build platform is continuously rotatedand raised. Accordingly, the object geometry can be continuously builtup along a spiral build path. Such methods are described in U.S. PatentPublication No. 2014/0265034, the disclosure of which is incorporatedherein by reference in its entirety.

The direct fabrication approaches provided herein are compatible with awide variety of materials. The properties of the materials used can beselected according to the desired properties for the correspondingportions of the appliance. Optionally, the direct fabrication methodsdescribed herein allow for fabrication of an appliance includingmultiple materials, referred to herein as “multi-material directfabrication.” In some embodiments, a multi-material direct fabricationmethod involves concurrently forming an object from multiple materialsin a single manufacturing step. For instance, a multi-tip extrusionapparatus can be used to selectively dispense multiple types ofmaterials from distinct material supply sources in order to fabricate anobject from a plurality of different materials. Such methods aredescribed in U.S. Pat. No. 6,749,414, the disclosure of which isincorporated herein by reference in its entirety. Alternatively or incombination, a multi-material direct fabrication method can involveforming an object from multiple materials in a plurality of sequentialmanufacturing steps. For instance, a first portion of the object (e.g.,an appliance shell) can be formed from a first material in accordancewith any of the direct fabrication methods herein, then a second portionof the object (e.g., one or more elastics) can be formed from a secondmaterial in accordance with methods herein, and so on, until theentirety of the object has been formed.

Direct fabrication can provide various advantages compared to othermanufacturing approaches. For instance, in contrast to indirectfabrication, direct fabrication permits production of an orthodonticappliance without utilizing any molds or templates for shaping theappliance, thus reducing the number of manufacturing steps involved andimproving the resolution and accuracy of the final appliance geometry.Additionally, direct fabrication permits precise control over thethree-dimensional geometry of the appliance, such as the appliancethickness. In many embodiments, direct fabrication allows for theentirety of the appliance (e.g., shell, discontinuities, elastics,and/or other auxiliary components) to be integrally produced in a singlestep, thus obviating the need for additional steps, e.g., to form adiscontinuity in the shell and/or couple an elastic or an auxiliarycomponent to the shell. For example, using direct fabricationtechniques, various types of discontinuities (e.g., cuts, flaps,apertures, deformations, etc.) can be formed concurrently with theforming of the appliance shell, rather than being formed in a separatematerial removal step. This approach can advantageously improve theaccuracy and fidelity with which the discontinuity is formed, as well asavoid the possibility of damage to the appliance shell by the materialremoval process.

Complex structures and/or auxiliary components can be formed integrallyas a single piece with the appliance shell in a single manufacturingstep, rather than being added to the shell in a separate manufacturingstep. In some embodiments, direct fabrication is used to produceappliance geometries that would be difficult to create using alternativemanufacturing techniques, such as appliances with very small or finefeatures, complex geometric shapes, undercuts, interproximal structures,shells with variable thicknesses, and/or internal structures (e.g., forimproving strength with reduced weight and material usage). Any of thestructures described herein (e.g., reservoir, ports, pores, channels,etc.) can be easily fabricated as integrally formed structures withinthe appliance using the methods described herein (e.g., directfabrication). For example, in some embodiments, the direct fabricationapproaches herein permit fabrication of an orthodontic appliance withfeature sizes of less than or equal to about 5 μm, or within a rangefrom about 5 μm to about 50 μm, or within a range from about 20 μm toabout 50 μm.

The direct fabrication techniques described herein can be used toproduce appliances with substantially isotropic material properties,e.g., substantially the same or similar strengths along all directions.In some embodiments, the direct fabrication approaches herein permitproduction of an orthodontic appliance with a strength that varies by nomore than about 25%, about 20%, about 15%, about 10%, about 5%, about1%, or about 0.5% along all directions. Additionally, the directfabrication approaches herein can be used to produce orthodonticappliances at a faster speed compared to other manufacturing techniques.In some embodiments, the direct fabrication approaches herein allow forproduction of an orthodontic appliance in a time interval less than orequal to about 1 hour, about 30 minutes, about 25 minutes, about 20minutes, about 15 minutes, about 10 minutes, about 5 minutes, about 4minutes, about 3 minutes, about 2 minutes, about 1 minutes, or about 30seconds. Such manufacturing speeds allow for rapid “chair-side”production of customized appliances, e.g., during a routine appointmentor checkup.

In some embodiments, the direct fabrication methods described hereinimplement process controls for various machine parameters of a directfabrication system or device in order to ensure that the resultantappliances are fabricated with a high degree of precision. Suchprecision can be beneficial for ensuring accurate delivery of a desiredforce system to the teeth in order to effectively elicit toothmovements. Process controls can be implemented to account for processvariability arising from multiple sources, such as the materialproperties, machine parameters, environmental variables, and/orpost-processing parameters.

Material properties may vary depending on the properties of rawmaterials, purity of raw materials, and/or process variables duringmixing of the raw materials. In many embodiments, resins or othermaterials for direct fabrication should be manufactured with tightprocess control to ensure little variability in photo-characteristics,material properties (e.g., viscosity, surface tension), physicalproperties (e.g., modulus, strength, elongation) and/or thermalproperties (e.g., glass transition temperature, heat deflectiontemperature). Process control for a material manufacturing process canbe achieved with screening of raw materials for physical propertiesand/or control of temperature, humidity, and/or other process parametersduring the mixing process. By implementing process controls for thematerial manufacturing procedure, reduced variability of processparameters and more uniform material properties for each batch ofmaterial can be achieved. Residual variability in material propertiescan be compensated with process control on the machine, as discussedfurther herein.

In one embodiment, direct fabrication (e.g., 3D printing) is used topattern an ornamental design, layer by layer, using a colored materialthat is different from the material used for the rest of the alignerstructure. According to another embodiment, direct fabrication (e.g., 3Dprinting) is used to create, layer by layer, a cavity or reservoir inthe aligner in the shape of a pattern that can be filled with either acolored liquid (e.g., medical grade substance, compliance indicatorsubstance, or medicine) or a colored direct fabrication resin using a 3Dprinting technique (e.g., stereolithography, photolithography,sintering, etc.). In an embodiment, the colored liquid or resin can beadded after fabrication of the shell appliance and sealed to form theornamental design.

An integrally formed reservoir or cavity may further include featuresfor receiving and releasing an agent. In the embodiment shown in FIGS.7A-7D, a cavity or reservoir 710 is formed, using a direct fabricationtechnique, near the exterior surface of a shell appliance 700. Thecavity 710 is provided with a feed channel 720 extending to the exteriorsurface of the appliance 700. After direct fabrication of the shellappliance 700, the cavity 710 is filled through the feed channel 720with a biocompatible colored liquid or resin having a suitableviscosity. In some embodiments, the liquid or resin is curable. Inaddition to the feed channel 720, a vent 730 is also provided to allowuncured liquid or resin to drain, and also to allow air to escape whilethe colored liquid or resin is injected into the cavity 710 through thefeed channel 720.

Typically, the appliance 700 has a thickness T of about 0.5 mm. In theillustrated embodiment, as shown in FIG. 7B, the appliance has athickness t of about 50-100 μm in front of and behind the cavity 710.According to an embodiment, the feed channel 720 and the vent each has adiameter in a range of about 50-100 μm. The cavity 710, which can beshaped in an ornamental pattern or design, can have channels having awidth in a range of about 50 μm-5 mm and a depth of about 100-200 μm.

As shown in FIG. 7C, the colored liquid or resin can be cured in thecavity 710 to solidify the ornamental design 740 in the cavity 710 suchthat the ornamental design 740 is solid like the appliance 700. Afterthe liquid or resin is cured, a clear coating or layer 750 is applied toseal it within the cavity 710 in the shell appliance 700, as shown inFIG. 7D. The clear coating or layer 750 can be sprayed or deposited tocover the openings of the feed channel 720 and the vent 730 to seal theliquid or resin within the cavity 710. It will be understood that thefeed channel 720 and vent 730 can be provided at any suitable locationon the cavity 710.

Alternatively, in another embodiment, the colored liquid (such as acompliance indicator substance or medicine) can be allowed to dissipatethrough a hole in the appliance portion covering the cavity. The holeopens due to heat when the shell appliance is placed in a patient'smouth. In another embodiment, the colored liquid can be allowed todissipate or chemically change colors due to the interaction or saliva,light, and/or heat over time to indicate compliance. According to yetanother embodiment, direct fabrication (e.g., 3D printing) is used tocreate a pattern on the outside or inside of the aligner so that thepattern can be painted to create an ornamental design.

A channel may also be integrally formed into the shell of the appliance.Integral formation of channels can be performed by direct fabrication asdescribed herein. In some aspects of the embodiments, a channel may beoperably connected to an integrally formed reservoir. In some aspects ofthe embodiments, a channel may have a plurality of geometries includingshapes, dimensions, angles and the like. Shapes of a x-axial crosssection or a y-axial cross section of the integrally formed channelinclude, but are not limited to, a circle, an oval, an ellipse, a curvedstructure with a complex shape, a triangle, a square, a rectangle, atriangle, a polygon, a pentagon, a hexagon, a heptagon, and the like.The integrally formed channel may have walls which are straight orcurved, as such, the walls of the integrally formed channel may or maynot form angles. The integrally formed channel may have a path withinthe aligner shell. For example, a path of the channel includes thedistance and direction of the channel from the outlet port or universalport of the integrally formed reservoir to the channel outlet port. Insome aspects, the channel has a plurality of outlet ports, and in theseaspects, the path includes the distance and direction of the channelfrom the outlet port or universal port of the integrally formedreservoir to each of the plurality of the channel outlet ports. The pathof the channel includes at least one segment and may include a pluralityof segments. For example, at least one segment may be a straight or acurved path between the outlet port or the universal port of theintegrally formed reservoir. The segments may have any of a plurality ofgeometries as described herein or known to one of ordinary skill in theart. Segment geometries include, but are not limited to, straight,curve, arc, angle, turn, spiral, circle, elbow, hairpin and the like.Segment geometries may distribute through a single plane (e.g., x-axis,y-axis, z-axis) of the shell or may distribute through a plurality ofplanes through the aligner shell. A person of ordinary skill in the artmay appreciate the endless possibilities of channel geometries andcomplex channel configurations that may be integrally formed into thealigner shell. The description of the channel herein is not limiting toany configuration of an integrally formed channel within the alignershell.

The direct fabrication approaches provided herein are compatible with awide variety of materials, including but not limited to one or more ofthe following: a polyester, a co-polyester, a polycarbonate, athermoplastic polyurethane, a polypropylene, a polyethylene, apolypropylene and polyethylene copolymer, an acrylic, a cyclic blockcopolymer, a polyetheretherketone, a polyamide, a polyethyleneterephthalate, a polybutylene terephthalate, a polyetherimide, apolyethersulfone, a polytrimethylene terephthalate, a styrenic blockcopolymer (SBC), a silicone rubber, an elastomeric alloy, athermoplastic elastomer (TPE), a thermoplastic vulcanizate (TPV)elastomer, a polyurethane elastomer, a block copolymer elastomer, apolyolefin blend elastomer, a thermoplastic co-polyester elastomer, athermoplastic polyamide elastomer, or combinations thereof. Thematerials used for direct fabrication can be provided in an uncured form(e.g., as a liquid, resin, powder, etc.) and can be cured (e.g., byphotopolymerization, light curing, gas curing, laser curing,crosslinking, etc.) in order to form an orthodontic appliance or aportion thereof. The properties of the material before curing may differfrom the properties of the material after curing. Once cured, thematerials herein can exhibit sufficient strength, stiffness, durability,biocompatibility, etc. for use in an orthodontic appliance. Thepost-curing properties of the materials used can be selected accordingto the desired properties for the corresponding portions of theappliance.

In some embodiments, relatively rigid portions of the orthodonticappliance can be formed via direct fabrication using one or more of thefollowing materials: a polyester, a co-polyester, a polycarbonate, athermoplastic polyurethane, a polypropylene, a polyethylene, apolypropylene and polyethylene copolymer, an acrylic, a cyclic blockcopolymer, a polyetheretherketone, a polyamide, a polyethyleneterephthalate, a polybutylene terephthalate, a polyetherimide, apolyethersulfone, and/or a polytrimethylene terephthalate. In someembodiments, relatively elastic portions of the orthodontic appliancecan be formed via direct fabrication using one or more of the followingmaterials: a styrenic block copolymer (SBC), a silicone rubber, anelastomeric alloy, a thermoplastic elastomer (TPE), a thermoplasticvulcanizate (TPV) elastomer, a polyurethane elastomer, a block copolymerelastomer, a polyolefin blend elastomer, a thermoplastic co-polyesterelastomer, and/or a thermoplastic polyamide elastomer.

Machine parameters can include curing parameters. For digital lightprocessing (DLP)-based curing systems, curing parameters can includepower, curing time, and/or grayscale of the full image. For laser-basedcuring systems, curing parameters can include power, speed, beam size,beam shape and/or power distribution of the beam. For printing systems,curing parameters can include material drop size, viscosity, and/orcuring power. These machine parameters can be monitored and adjusted ona regular basis (e.g., some parameters at every 1-x layers and someparameters after each build) as part of the process control on thefabrication machine. Process control can be achieved by including asensor on the machine that measures power and other beam parametersevery layer or every few seconds and automatically adjusts them with afeedback loop. For DLP machines, gray scale can be measured andcalibrated before, during, and/or at the end of each build, and/or atpredetermined time intervals (e.g., every n^(th) build, once per hour,once per day, once per week, etc.), depending on the stability of thesystem. In addition, material properties and/or photo-characteristicscan be provided to the fabrication machine, and a machine processcontrol module can use these parameters to adjust machine parameters(e.g., power, time, gray scale, etc.) to compensate for variability inmaterial properties. By implementing process controls for thefabrication machine, reduced variability in appliance accuracy andresidual stress can be achieved.

Determination of the appliance geometry, material composition, and/orproperties can be performed using a treatment or force applicationsimulation environment. A simulation environment can include, e.g.,computer modeling systems, biomechanical systems or apparatus, and thelike. Optionally, digital models of the appliance and/or teeth can beproduced, such as finite element models. The finite element models canbe created using computer program application software available from avariety of vendors. For creating solid geometry models, computer aidedengineering (CAE) or computer aided design (CAD) programs can be used,such as the AutoCAD® software products available from Autodesk, Inc., ofSan Rafael, Calif. For creating finite element models and analyzingthem, program products from a number of vendors can be used.

In various embodiments, a computing system can be used in the design ofdental appliances thereof that can be used in association with thefabrication of embodiments. Such a computing system may include one ormore computing devices having, for example, a processor and memory. Thememory can include various types of information including data (e.g.,dentition measurement, uploaded images for ornamental designs, and/ordigital model data) and/or executable instructions to perform themethods discussed herein. Various embodiments can include one or moreinput and/or output interfaces. Such interfaces can be used, forinstance, to connect the computing device with one or more input oroutput devices. For example, a system may include connectivity to ascanning device, a camera dock, a keyboard, and/or other peripherals.

Some embodiments can include a network interface. Such an interface canallow, for example, for processing on another networked computingdevice. Such devices can be used to obtain information about the patientor executable instructions for use with various embodiments providedherein, in some instances. For example, in an embodiment, a patient canselect an ornamental design to be integrated with his or her dentalappliances. This selection can be made in the patient's home or otherlocation via a network interface. The designs can be uploaded to awebsite of the dentist, orthodontist, or manufacturer of appliances.

Alternatively, a patient can design a customized image and upload theimage to the dentist, orthodontist, or manufacturer via a networkinterface. In some embodiments, the image is first scanned and thenuploaded. The uploaded image(s) can be integrated into the patient'sappliance or series of appliances. As noted above, the design can becompletely customizable.

Such connectivity can allow for the input of image information (e.g.,scanned images and/or digital pictures, etc.), and instructions (e.g.,input via keyboard), among other types of information. Although someembodiments may be distributed among various computing devices withinone or more networks, such systems can be beneficial in allowing for thecapture, calculation, and/or analysis of the various informationdiscussed herein.

FIG. 8 is a flow chart of a process 800 for selecting an image forintegration with a dental appliance. In step 810, the patient isprovided with a selection of images and/or the ability to create acustomized image for use as an ornamental design integrated with thedental appliance. A website associated with a dentist or orthodontist ora manufacturer of dental appliances can be used to provide the selectionof images and/or the ability to create the customized image. The patientcan then select the image or upload a customized image from thepatient's computer to the website via a network for use as theornamental design in step 820. As noted above, a customized image can becreated on a computer and then uploaded to the website or the customizedimage can be scanned using a scanner and uploaded to the website.Alternatively, the customized image can be created directly on thewebsite. The image is then stored on a server associated with thewebsite. The dental appliance can then be fabricated with the selectedornamental design integrated thereon in step 830 by obtaining theselected design from the server. As noted above, there are a variety ofmethods for fabricating the dental appliances described herein. Digitaldesign can identify where to build up appliance thickness to accommodatethe desired design. For example, the thickness of the appliance is knownfor prefabricated design. However, for laser-activated or etched design,a thicker layer may be needed in certain areas. Added thickness can becreated by additional colored layers, or spray, painted, or dippedlayers. To create a smooth transition, additional thickness can beprovided at locations in recessed portions to receive material printedwith the ornamental designs.

As discussed above, an appliance for intra-oral delivery of one or moreagents to a patient is described herein. The appliance includes a shellforming a plurality of cavities shaped to receive teeth of a mouth ofthe patient and a reservoir. The reservoir is integrally formed withinthe shell, and the reservoir is configured to receive, store and releasean agent to the patient. A channel can be integrally formed within theshell. The shell and the reservoir can comprise a first material.According to another embodiment, the shell comprises a first materialand the reservoir comprises a second material. In yet anotherembodiment, the reservoir comprises a first material and a secondmaterial. In some embodiments, the reservoir is hollow or can be filledwith a porous material. The porous material can comprise the secondmaterial or a third material. The porous material can be a degradablematerial or a material configured to release an agent by diffusion. Theporous material can have pores having a diameter of about 50 μm, about30 μm, about 20 μm, about 15 μm, about 10 μm, about 5 μm, about 1 μm,about 500 nm, about 100 nm, about 10 nm, or about 1 nm. The porousmaterial can comprise pores having the same diameter or having differentdiameters. The reservoir can comprise at least one port, wherein the atleast one port is an outlet port, an inlet port or a universal port.

According to another embodiment, a method is described for fabricatingan appliance for intra-oral delivery of one or more agents to a patient.A digital model of the appliance is generated. The digital modelcomprises a digital representation of a shell comprising a plurality ofteeth receiving cavities and a digital representation of a reservoirintegrally formed within the shell. Instructions are then generated forfabricating the appliance with the shell and integrally formed reservoirusing a direct fabrication technique, based on the digital model. Thedirect fabrication technique can be one or more of: stereolithography,selective laser sintering, fused deposition modeling, or 3D printing Theinstructions can be configured to control a fabrication machine to formthe reservoir concurrently with the shell.

Although only a few embodiments of the invention have been described indetail, it should be appreciated that the invention may be implementedin many other forms without departing from the spirit or scope of theinvention. In view of all of the foregoing, it should be apparent thatthe present embodiments are illustrative and not restrictive and theinvention is not limited to the details given herein, but may bemodified within the scope and equivalents of the appended claims.

What is claimed is:
 1. A method of providing a design on a dentalappliance having a geometry configured to receive teeth, the methodcomprising: providing the appliance comprising a plurality of layers,wherein each of the plurality of layers is associated with a color; andaltering an appearance of at least a portion of the appliance to providethe design on the appliance by directing an etching device, heat, orlight energy to at least a portion of the appliance to alter a materialproperty of the at least a portion of the appliance, wherein alteringthe material property further comprises removing at least a portion ofone of the plurality of layers from the appliance to reveal the colorassociated with an underlying layer of the appliance.
 2. The method ofclaim 1, wherein the etching device is a laser or milling tool.
 3. Themethod of claim 1, further comprising: providing on a website aselection of images or an ability to upload or create a customized imagefor use as the design integrated with the dental appliance; allowingselecting of an image from the selection or uploading of a customizedimage to the website via a network for use as the design for integrationwith the dental appliance; and storing the selected or uploaded image ona server associated with the website.
 4. The method of claim 3, whereinaltering an appearance of at least a portion of the appliance comprisesdirecting an etching device, heat, or other light energy to at least aportion of the appliance to alter a material property of the at least aportion of the appliance to create a design selected or uploaded fromthe server.
 5. The method of claim 3, wherein the website is associatedwith a dentist or orthodontist or a manufacturer of dental appliances.6. The method of claim 3, wherein the customized image can be created ona computer and then uploaded to the website.
 7. The method of claim 3,wherein the customized image can be scanned using a scanner and uploadedto the website.
 8. The method of claim 3, wherein the customized imagecan be created directly on the website.
 9. The method of claim 3,wherein the design dictates layers used to build the appliance near thedesign.
 10. The method of claim 1, wherein each layer has depth toaccommodate colors desired in the design.
 11. A method of fabricating adental appliance having an ornamental design thereon, the dentalappliance having a geometry shaped to receive teeth, the methodcomprising: forming the appliance from a sheet comprising a plurality oflayers; and directing an etching device, heat, or light energy to atleast a portion of the appliance to remove at least one layer ofmaterial from the appliance to reveal a portion of a layer of theappliance.
 12. The method of claim 11, wherein each layer is associatedwith a particular color and wherein directing an etching device, heat,or light energy to at least a portion of the appliance to remove atleast one layer of material from the appliance reveals a colorassociated with the layer with a portion thereof revealed.
 13. A methodof fabricating a dental appliance having an ornamental design thereon,the dental appliance having a geometry shaped to receive teeth, themethod comprising: forming the appliance from a sheet comprising aplurality of layers, wherein one of the plurality of layers is printedor etched with an ornamental design before being assembled with theother layers; and directing an etching device, heat, or light energy toat least a portion of the appliance to remove at least one layer ofmaterial from the appliance to reveal a portion of a layer of theappliance.